WHEN PATIENTS SOUND off (sometimes to the point of being rude) about wanting a different doctor—because they disagree with the treatment or discharge plan or pain regimen—many physicians feel comfortable sitting down with that patient and family and trying to get to the bottom of their concerns.
That’s according to Ijeoma Carol Nwelue, MD, chief of hospital medicine at Baylor Scott & White All Saints Medical Center in Ft. Worth, Texas. But sometimes, Dr. Nwelue says, such a rude confrontation also entails a bit of education for the provider involved.
“For some physicians, the instinct is to respond, ‘Well, I’m the doctor, I went to school for years and I know what I’m doing! How many years did you go to medical school?!’ ” she says. “Saying that to patient or family and getting defensive doesn’t help.” That’s when she’ll sit down with that physician and have a conversation.
“When patients or families get angry, the best thing you can do is get a chair, sit in the room and talk it out.”
Chris Reynolds, MD
Rochester Regional Health
Usually, she adds, when patients lash out in a rude way (as long as they aren’t cognitively or psychiatrically impaired), they are coming from a place of fear.
While it’s perfectly human to feel defensive when someone questions your credentials, Dr. Nwelue reminds physicians and APPs to remember that this—a request for a different doctor or skepticism about a treatment or discharge plan—”is not about you,” meaning the provider. “This may be the worst day of that patient’s life if they have received a life-threatening diagnosis or learned about a life-altering condition, like having new onset diabetes requiring insulin. Just remembering that goes a long way.”
Instead of “I went to such and such medical school,” she coaches providers to put themselves into the patient’s situation, even if the patient could have been (a lot) nicer. “We should instead be saying, ‘I appreciate this is all new and probably a little scary, and I understand that this is a lot. I want to assure you that we are doing everything we can to help you through this process. ‘ ”
As Chris Reynolds, MD, site director for the hospitalist program at Rochester General Medical Center in Rochester, N.Y., points out, doctors tend to become more comfortable handling such conversations as they gain more experience.
“When patients or families get angry, the initial gut response that many new hospitalists have is to walk away,” Dr. Reynolds says. “But the best thing you can do with someone who’s angry or upset is to walk toward them. The functional response is to get a chair, sit in the room and talk it out.”
Fortunately, he adds, even with younger colleagues who may need a bit of coaching before they feel ready to have that conversation, “90% or 95% of the time, it works out OK. It’s quite uncommon for relationships to fracture completely.”
